Dependent Agency in the Global Health Regime: Local African Responses to Donor AIDS Efforts

148 Pages·2017·4.37 MB·English

by  Emma-Louise Anderson

Dependent Agency in the Global
Health Regime
Emma-LouiseAnderson(cid:129)AmyS.Patterson
Dependent Agency
in the Global Health
Regime
Local African Responses to Donor AIDS Efforts
Emma-LouiseAnderson AmyS.Patterson
UniversityofLeeds UniversityoftheSouth
Leeds,UnitedKingdom Sewanee,Tennessee,USA
ISBN978-1-137-58147-1 ISBN978-1-137-58148-8(eBook)
DOI10.1057/978-1-137-58148-8
LibraryofCongressControlNumber:2016952419
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To Isabel,Sophia, Neil, Max,and Alex,
With love and gratitude
A
CKNOWLEDGMENTS
This project had its roots in pure luck. Both of us attended the 2014
International Studies Association (ISA) conference, each presenting a
paper on community responses to donor AIDS programs in Africa. Not
knowing one another before the conference, we just happened to read
each other’s conference papers. As we did, we noticed many similarities:
our respondents talked about AIDS donor programs using the same
jargon; they exhibited both dependence on global aid structures and an
uncannyabilitytomaneuveraroundthosestructures;theychallengedhow
we as political scientists thought about the structure–agency debate. The
morewediscussedourfieldwork,themoreweknewwewantedtowritea
bookthatanalyzedthe“backstory”ofdonorAIDSprograms.Thatis,we
wanted to see the ways that local people—often described as “victims,”
“helpless,” and “dependent”—demonstrated autonomy in their actions
and reactions as they were caught up in the highly funded donor AIDS
programs in Malawi and Zambia. As we each recounted stories of these
dependent agents, we began to ask: What makes such agency possible?
And why might it matter? Over the course of working together we have
been fortunate that we have been able to “pick up the slack” for one
another when other projects, family obligations, and teaching require-
mentsdrew our attention fromthe book.
IndevelopingthisworkwehavebenefitedfromthesupportoftheGlobal
HealthSectionattheISA.Wewereencouragedtoputtogethertwopanels
onAfricanAgencyandHealthforthe2015conference,whichprovidedthe
space to further develop this collaborative project. We thank the panel
participants for the ways their work challenged our own thinking: Sophie
vii
viii ACKNOWLEDGMENTS
Harman, Valerie Percival, Moritz Hunsmann, Peter Kingsley, Fanny
Chabrol,AnnamarieBindenagel,ReneUmlauf,andAshleyFox.Weexpress
our particulargratitudetoSophieHarmanforherconsidered feedbackon
our papers and her encouragement for our project. We also extend our
appreciation to our colleagues. Emma thanks her colleagues at the
University of Leeds, particularly Alex Beresford, James Souter, Gordon
Crawford,RayBush,andMichaelThomson.Amythankshercolleaguesat
the University oftheSouth for their supportand encouragement, particu-
larlyMelodyCrowder-Meyer,PaigeSchneider,andMichaelWairungu.And
she has benefited greatly from the wisdom of Gideon Byamugisha and
PhoebeKajubi.
Wearealsogratefulforthefinancialresourcesandpersonalsupportthat
madetheprojectpossible.FundingfortheZambiafieldworkwasprovided
by the Fulbright ScholarProgram, a Calvin CollegeAlumni Grant,anda
FacultyResearchGrantfromtheUniversity oftheSouth,whilethe work
in Malawi was funded by the Economic and Social Research Council
(ESRC) and Faculty Research Grants from Keele University and the
University of Leeds. In Zambia, Sylvia Mwamba and Manenga Ndulo at
the Department of Health Economics, University of Zambia; Moses
Mwale and D.T. Banda at Justo Mwale Theological College; Lawrence
TemfweatJubileeCentre;BishopJoshuaBandaatNorthmeadAssembly
of God; John Masuwa at the Network for Zambian People Living with
HIV(NZP+);PiersonBanda,HIV/AIDSCoordinatorfortheReformed
Church of Zambia; Gershom Kapalaula of the Zambia Network of
Religious Leaders Living with or Personally Affected by HIV and AIDS;
Michael Kelly of the Jesuit Centre for Theological Reflection; Angela
Konayuma of the Christian Council of Zambia; and Troy Lewis of the
Expanded Church Response Trust provided crucial assistance. Amy also
thanksstaffattheCircleofHopeAIDSclinic,clinicslinkedtotheCentre
forInfectiousDiseaseResearchinZambia,theChristianReformedWorld
ReliefCommittee,andtheHelenDeVosChristianHighSchool,aswellas
JulieLimpic, the EliToribiofamily, andseveral NZP+ groupleaders.
TheworkinMalawibenefitedfromthesupportofJaneAnsah,Attorney
General; Kate Kainja, Minister for Women and Child Development;
Anthony Kamanga, Law Commissioner; Francis Cooke, Headmaster at
KamuzuAcademy;EmmanuelFabiano,ViceChancellorattheUniversity
of Malawi; Paul Kishindo, Director of the Centre for Social Research
(CSR);andAlisterMunthaliwithCSR.Thelocal-levelfieldworkbenefited
from the guidance and support of the National Coordinator of the
ACKNOWLEDGMENTS ix
“Women, Girls and HIV/AIDS: Program and National Plan of Action”;
the Head of Monitoring and Evaluation at the National AIDS
Commission (NAC); a representative of the Department for Nutrition,
HIV and AIDS; Program Officer for Monitoring and Evaluation at the
Malawi Network of People Living with HIV (MANET+); Assistant
Programme Manager at the National Association for People Living with
HIV and AIDS in Malawi (NAPHAM); National Coordinator at the
Coalition of Women and Girls Living with HIV/AIDS; National
Coordinator of the Malawi Network of Religious Leaders Living with
HIV and AIDS (MANERELA); Programme Coordinator of the Malawi
Network of AIDS Service Organisations (MANASO); a representative of
the National Statistics Office (NSO); and the District Coordinators for
NAPHAM in Zomba and Karonga. Emma is grateful to Al Mtenje,
Director for the Centre of Language Studies; Russell Msiska, who acted
as the facilitator and translator for the focus group discussions; and
Kondwani Klinga, who assisted in Zomba. We both thank all the partici-
pantsinthekeyinformantinterviews,focusgroupdiscussions,participant
observations, andinformaldiscussionsfor theirtimeandhospitality.
And,ofcourse,ourimmeasurablegratitudetoourfamiliesandpartners
for putting up with our late nights and early mornings at the computer,
weekends at the office, and weeks away from home doing fieldwork.
Thank you Isabel, Sophia, and Neil Patterson for your patience, love,
and desire to learn about and care for people who live far from your
small town in Tennessee. Thank you Alex Beresford for your love, sup-
port, and ability to still provide critical feedback despite the pressures of
balancingbeingafathertoournewbornsonwithyourownwork.Thank
you Max for being such a cheerful and laid-back little man that your
mothercould find the timetofinishup thisprojectwhile you slept.
C
ONTENTS
1 DependentAgency andthe AIDS Enterprise:Global
Programs, LocalActions 1
2 UniqueOpportunities in aDynamic AidArchitecture:
TheConditions for Agency 33
3 Performing,Extraverting,and Resisting:The Strategies
ofDependent Agents 53
4 ComplexPower onthe Margins:The Implications
ofDependent Agency 87
Bibliography 113
Listof Fieldwork Data 131
Index 137
xi
A
CRONYMS
AIDS acquiredimmunedeficiencysyndrome
ART antiretroviraltherapy
ARVs antiretrovirals
BRICS Brazil,Russia,India,ChinaandSouthAfrica
CD4 clusterofdifferentiation4
CHAZ ChurchesHealthAssociationofZambia
CBO community-basedorganization
COWLHA CoalitionofWomenLivingwithHIVandAIDS
DfID DepartmentforInternationalDevelopment
FBO faith-basedorganization
FGD focusgroupdiscussion
GDP grossdomesticproduct
GNI grossnationalincome
HBC home-basedcare
HIV humanimmunodeficiencyvirus
MANASO MalawiNetworkofAIDSServiceOrganisations
MANET+ MalawiNetworkofPeopleLivingwithHIV/AIDS
MoH MinistryofHealth
MOU memorandumofunderstanding
MWK Malawiankwacha
NACMalawi NationalAIDSCommission(Malawi)
NACZambia NationalAIDSCouncil(Zambia)
NAPHAM National Association for People Living with HIV and AIDS in
Malawi
NGO nongovernmentalorganization
NZP+ NetworkofZambianPeopleLivingwithHIV/AIDS
OECD OrganisationforEconomicCo-operationandDevelopment
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